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SAN JDAQUIN Environmental Health Department COUNTY— .:_ 5 Lfr TEMPORARY FOOD VENDOR'S APPLICATION All food vendors(both for profit and non-profit)are required to return a signed and completed copy of this checklist to the festival coordinator three(3)weeks prior to this event. 1. 1.Name of went: Lodi Street Faire Date(s): 5-4-2025 2. The following is information about my organizabonibusiness: Name of organizatiowbusiness: Mar Val Food Stores Address: 856 N Sacramento St Ste C Lodi, CA 95240 Phone: (209 ) 369-3611 Attemate:(209 ) 747-7452 3. List food to be sold or given to the public: Smoked Sausage, Bacon, Smoked Cheese _ 4_ 1 am providing food that is NOT prepared at home:M Yes❑No All food is prepared on-site or is from approved commercial facilities=R Yes❑No Name of facility. Artisan Butcher, Mar Val Food Stores phone:(209) 772-2393 Address of facility:55 Hwy 26 Valfet Springs. CA 95252 5. 1 am providing a booth with the folkWng:(to protect my unpackaged food and food-preparation areas from flies, dust and the public) ❑A booth with walls and ceiling constructed of either wood,canvas, plastic,similar material and fine mesh fly screening, completety enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. ❑x other(specify): Food in packaged Nate: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers,or prepackaged foods from approved sources. 6_ Approved water for drinking,utensil and hand washing will be provided in my booth by the following methods: ®Approved bottled water. ❑On-site hose bib that is connected to a potable water source. ❑Other(specify): 7. Electricity is provided for my booth's use:L]Yes®No 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation:®Yes❑No 9. 1 am providing the following hot temperature contral for the hot holding of all potentially hazardous foods above 13ST: ❑Camp stove ❑Stemo&hotel trays ❑Double steamer ❑Steam table 8 rids ❑Electric stove top Other(specify) NIA Note: Examples of potentiaQy hazardous food Include: meats, tamales, cooked beans, rtce, vegetables,potato salad,eggs,and dairy products. 1868 E.Hazelton Avenue I Stockton,California 95205 f T 209 468-3420( F 209 464-0138 { wAv.s}cehd.com EMS 1"2 Page d 11 TEW EVENT AAA o7JUM7